Individual
ROBERT DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 S 4TH AVE, POCATELLO, ID 83201-6404
(208) 478-9081
Mailing address
420 S 4TH AVE, POCATELLO, ID 83201-6404
(208) 590-8259
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC10498
ID
101YM0800X
Mental Health Counselor
Primary
LPC-10498
ID
101YP2500X
Professional Counselor
Primary
9261605
ID
Other
Enumeration date
05/23/2024
Last updated
05/26/2026
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